Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS

Facility

$37,610.07

Service Code	MSDRG 864
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,610.07
Rate for Payer: Aetna of CA HMO/PPO	$27,223.77
Rate for Payer: EPIC Health Plan Commercial	$37,610.07
Rate for Payer: EPIC Health Plan Senior	$27,859.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,859.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,859.31
Rate for Payer: Molina Healthcare of CA Medicare	$37,331.48
Rate for Payer: Multiplan WC	$16,775.94
Rate for Payer: Prime Health Services WC	$16,604.76
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FOOT PROCEDURES WITH CC

Facility

$53,204.58

Service Code	MSDRG 504
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,204.58
Rate for Payer: Aetna of CA HMO/PPO	$53,204.58
Rate for Payer: EPIC Health Plan Commercial	$49,779.22
Rate for Payer: EPIC Health Plan Senior	$36,873.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,873.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,873.50
Rate for Payer: Molina Healthcare of CA Medicare	$49,410.49
Rate for Payer: Multiplan WC	$32,785.95
Rate for Payer: Prime Health Services WC	$32,451.40
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FOOT PROCEDURES WITH MCC

Facility

$80,234.33

Service Code	MSDRG 503
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$80,234.33
Rate for Payer: Aetna of CA HMO/PPO	$80,234.33
Rate for Payer: EPIC Health Plan Commercial	$62,439.70
Rate for Payer: EPIC Health Plan Senior	$46,251.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,251.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,251.63
Rate for Payer: Molina Healthcare of CA Medicare	$61,977.18
Rate for Payer: Multiplan WC	$49,442.33
Rate for Payer: Prime Health Services WC	$48,937.82
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FOOT PROCEDURES WITHOUT CC/MCC

Facility

$53,204.58

Service Code	MSDRG 505
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,204.58
Rate for Payer: Aetna of CA HMO/PPO	$53,204.58
Rate for Payer: EPIC Health Plan Commercial	$49,779.22
Rate for Payer: EPIC Health Plan Senior	$36,873.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,873.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,873.50
Rate for Payer: Molina Healthcare of CA Medicare	$49,410.49
Rate for Payer: Multiplan WC	$32,785.95
Rate for Payer: Prime Health Services WC	$32,451.40
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FRACTURES OF FEMUR WITH MCC

Facility

$46,511.86

Service Code	MSDRG 533
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,511.86
Rate for Payer: Aetna of CA HMO/PPO	$46,228.87
Rate for Payer: EPIC Health Plan Commercial	$46,511.86
Rate for Payer: EPIC Health Plan Senior	$34,453.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,453.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,453.23
Rate for Payer: Molina Healthcare of CA Medicare	$46,167.33
Rate for Payer: Multiplan WC	$28,487.35
Rate for Payer: Prime Health Services WC	$28,196.66
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FRACTURES OF FEMUR WITHOUT MCC

Facility

$36,417.30

Service Code	MSDRG 534
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,417.30
Rate for Payer: Aetna of CA HMO/PPO	$24,677.22
Rate for Payer: EPIC Health Plan Commercial	$36,417.30
Rate for Payer: EPIC Health Plan Senior	$26,975.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,975.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,975.78
Rate for Payer: Molina Healthcare of CA Medicare	$36,147.55
Rate for Payer: Multiplan WC	$15,206.70
Rate for Payer: Prime Health Services WC	$15,051.53
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$43,742.92

Service Code	MSDRG 535
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,742.92
Rate for Payer: Aetna of CA HMO/PPO	$40,317.25
Rate for Payer: EPIC Health Plan Commercial	$43,742.92
Rate for Payer: EPIC Health Plan Senior	$32,402.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,402.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,402.16
Rate for Payer: Molina Healthcare of CA Medicare	$43,418.89
Rate for Payer: Multiplan WC	$24,844.47
Rate for Payer: Prime Health Services WC	$24,590.96
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$36,373.29

Service Code	MSDRG 536
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,373.29
Rate for Payer: Aetna of CA HMO/PPO	$24,583.24
Rate for Payer: EPIC Health Plan Commercial	$36,373.29
Rate for Payer: EPIC Health Plan Senior	$26,943.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,943.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,943.18
Rate for Payer: Molina Healthcare of CA Medicare	$36,103.86
Rate for Payer: Multiplan WC	$15,148.79
Rate for Payer: Prime Health Services WC	$14,994.21
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$45,639.99

Service Code	MSDRG 562
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,639.99
Rate for Payer: Aetna of CA HMO/PPO	$44,367.47
Rate for Payer: EPIC Health Plan Commercial	$45,639.99
Rate for Payer: EPIC Health Plan Senior	$33,807.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,807.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,807.40
Rate for Payer: Molina Healthcare of CA Medicare	$45,301.92
Rate for Payer: Multiplan WC	$27,340.30
Rate for Payer: Prime Health Services WC	$27,061.32
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$37,550.45

Service Code	MSDRG 563
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,550.45
Rate for Payer: Aetna of CA HMO/PPO	$27,096.44
Rate for Payer: EPIC Health Plan Commercial	$37,550.45
Rate for Payer: EPIC Health Plan Senior	$27,815.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,815.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,815.15
Rate for Payer: Molina Healthcare of CA Medicare	$37,272.30
Rate for Payer: Multiplan WC	$16,697.49
Rate for Payer: Prime Health Services WC	$16,527.10
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$126,432.88

Service Code	MSDRG 793
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$126,432.88
Rate for Payer: Aetna of CA HMO/PPO	$126,432.88
Rate for Payer: EPIC Health Plan Commercial	$84,078.66
Rate for Payer: EPIC Health Plan Senior	$62,280.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,280.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,280.49
Rate for Payer: Molina Healthcare of CA Medicare	$83,455.86
Rate for Payer: Multiplan WC	$77,911.00
Rate for Payer: Prime Health Services WC	$77,115.99
Rate for Payer: United Healthcare All Other Commercial	$10,809.00
Rate for Payer: United Healthcare All Other HMO	$8,601.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$65,052.07

Service Code	MSDRG 934
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$65,052.07
Rate for Payer: Aetna of CA HMO/PPO	$65,052.07
Rate for Payer: EPIC Health Plan Commercial	$55,328.47
Rate for Payer: EPIC Health Plan Senior	$40,984.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,984.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,984.05
Rate for Payer: Molina Healthcare of CA Medicare	$54,918.63
Rate for Payer: Multiplan WC	$40,086.66
Rate for Payer: Prime Health Services WC	$39,677.62
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$202,477.53

Service Code	MSDRG 928
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$202,477.53
Rate for Payer: Aetna of CA HMO/PPO	$202,477.53
Rate for Payer: EPIC Health Plan Commercial	$119,697.21
Rate for Payer: EPIC Health Plan Senior	$88,664.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,664.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$88,664.60
Rate for Payer: Molina Healthcare of CA Medicare	$118,810.56
Rate for Payer: Multiplan WC	$124,771.56
Rate for Payer: Prime Health Services WC	$123,498.38
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$96,417.01

Service Code	MSDRG 929
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$96,417.01
Rate for Payer: Aetna of CA HMO/PPO	$96,417.01
Rate for Payer: EPIC Health Plan Commercial	$70,019.51
Rate for Payer: EPIC Health Plan Senior	$51,866.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,866.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,866.30
Rate for Payer: Molina Healthcare of CA Medicare	$69,500.84
Rate for Payer: Multiplan WC	$59,414.50
Rate for Payer: Prime Health Services WC	$58,808.23
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$38,858.22

Service Code	MSDRG 378
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,858.22
Rate for Payer: Aetna of CA HMO/PPO	$29,888.54
Rate for Payer: EPIC Health Plan Commercial	$38,858.22
Rate for Payer: EPIC Health Plan Senior	$28,783.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,783.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,783.87
Rate for Payer: Molina Healthcare of CA Medicare	$38,570.39
Rate for Payer: Multiplan WC	$18,418.04
Rate for Payer: Prime Health Services WC	$18,230.10
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$55,120.55

Service Code	MSDRG 377
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,120.55
Rate for Payer: Aetna of CA HMO/PPO	$55,120.55
Rate for Payer: EPIC Health Plan Commercial	$50,676.64
Rate for Payer: EPIC Health Plan Senior	$37,538.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,538.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,538.25
Rate for Payer: Molina Healthcare of CA Medicare	$50,301.25
Rate for Payer: Multiplan WC	$33,966.62
Rate for Payer: Prime Health Services WC	$33,620.03
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$33,899.67

Service Code	MSDRG 379
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,899.67
Rate for Payer: Aetna of CA HMO/PPO	$19,302.20
Rate for Payer: EPIC Health Plan Commercial	$33,899.67
Rate for Payer: EPIC Health Plan Senior	$25,110.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,110.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,110.87
Rate for Payer: Molina Healthcare of CA Medicare	$33,648.57
Rate for Payer: Multiplan WC	$11,894.49
Rate for Payer: Prime Health Services WC	$11,773.11
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$36,241.21

Service Code	MSDRG 389
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,241.21
Rate for Payer: Aetna of CA HMO/PPO	$24,301.31
Rate for Payer: EPIC Health Plan Commercial	$36,241.21
Rate for Payer: EPIC Health Plan Senior	$26,845.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,845.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,845.34
Rate for Payer: Molina Healthcare of CA Medicare	$35,972.76
Rate for Payer: Multiplan WC	$14,975.06
Rate for Payer: Prime Health Services WC	$14,822.25
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$45,730.89

Service Code	MSDRG 388
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,730.89
Rate for Payer: Aetna of CA HMO/PPO	$44,561.49
Rate for Payer: EPIC Health Plan Commercial	$45,730.89
Rate for Payer: EPIC Health Plan Senior	$33,874.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,874.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,874.73
Rate for Payer: Molina Healthcare of CA Medicare	$45,392.14
Rate for Payer: Multiplan WC	$27,459.86
Rate for Payer: Prime Health Services WC	$27,179.66
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$32,628.81

Service Code	MSDRG 390
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$32,628.81
Rate for Payer: Aetna of CA HMO/PPO	$16,588.92
Rate for Payer: EPIC Health Plan Commercial	$32,628.81
Rate for Payer: EPIC Health Plan Senior	$24,169.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,169.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,169.49
Rate for Payer: Molina Healthcare of CA Medicare	$32,387.12
Rate for Payer: Multiplan WC	$10,222.49
Rate for Payer: Prime Health Services WC	$10,118.18
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$46,237.82

Service Code	MSDRG 513
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,237.82
Rate for Payer: Aetna of CA HMO/PPO	$45,643.77
Rate for Payer: EPIC Health Plan Commercial	$46,237.82
Rate for Payer: EPIC Health Plan Senior	$34,250.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,250.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,250.24
Rate for Payer: Molina Healthcare of CA Medicare	$45,895.32
Rate for Payer: Multiplan WC	$28,126.79
Rate for Payer: Prime Health Services WC	$27,839.79
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$39,336.76

Service Code	MSDRG 514
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$39,336.76
Rate for Payer: Aetna of CA HMO/PPO	$30,910.19
Rate for Payer: EPIC Health Plan Commercial	$39,336.76
Rate for Payer: EPIC Health Plan Senior	$29,138.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,138.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,138.34
Rate for Payer: Molina Healthcare of CA Medicare	$39,045.38
Rate for Payer: Multiplan WC	$19,047.61
Rate for Payer: Prime Health Services WC	$18,853.25
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: HAND PROCEDURES FOR INJURIES

Facility

$66,164.67

Service Code	MSDRG 906
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$66,164.67
Rate for Payer: Aetna of CA HMO/PPO	$66,164.67
Rate for Payer: EPIC Health Plan Commercial	$55,849.61
Rate for Payer: EPIC Health Plan Senior	$41,370.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,370.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,370.08
Rate for Payer: Molina Healthcare of CA Medicare	$55,435.91
Rate for Payer: Multiplan WC	$40,772.27
Rate for Payer: Prime Health Services WC	$40,356.23
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: HEADACHES WITH MCC

Facility

$41,323.30

Service Code	MSDRG 102
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,323.30
Rate for Payer: Aetna of CA HMO/PPO	$35,151.40
Rate for Payer: EPIC Health Plan Commercial	$41,323.30
Rate for Payer: EPIC Health Plan Senior	$30,609.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,609.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,609.85
Rate for Payer: Molina Healthcare of CA Medicare	$41,017.20
Rate for Payer: Multiplan WC	$21,661.15
Rate for Payer: Prime Health Services WC	$21,440.11
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: HEADACHES WITHOUT MCC

Facility

$36,931.33

Service Code	MSDRG 103
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,931.33
Rate for Payer: Aetna of CA HMO/PPO	$25,774.66
Rate for Payer: EPIC Health Plan Commercial	$36,931.33
Rate for Payer: EPIC Health Plan Senior	$27,356.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,356.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,356.54
Rate for Payer: Molina Healthcare of CA Medicare	$36,657.76
Rate for Payer: Multiplan WC	$15,882.97
Rate for Payer: Prime Health Services WC	$15,720.90
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

Know your out-of-pocket cost for care.

All Charges